I saw my PCP (not my surgeon) today and based on labs taken yesterday, my urine has large amounts of ketones and she was concerned. However, when I reminded her that I had VSG she said to watch it since I was a diabetic but she really didn't go into much detail. She also said that I should follow-up with my surgeon and my endocrinologist (which I called a left a VM).
My PCP did tell me that ketones in the urine could be a sign of dehydration, however, I'm drinking 64 oz . of water plus 22-33 oz. (60-90gm) of protein shakes. I don't have any feelings of dizziness, thirst, or headaches. However, my urine is very dark yellow and has a strong smell.

In the meantime can anyone tell me if ketones in the urine is good, bad, etc.? From what I've read/heard its the state of when the body is burn/using fat instead of sugar (carbs) for energy but that it could be dangerous for long periods of time. Also, how can ketones in the urine affect diabetics?

I plan on calling both my surgeon and endocrinologist again in the morning but I wanted to see if anyone else has experienced this.

I don't know about them from a weight loss stand point, but I am a camp counselor for a juvenille diabetes camp. Any time we have a camper test with blood sugar over 250 we make them test for ketones and immediately sideline any camper testing positive for ketones and send them down to the on staff physician. According to the American Diabetes Association, this is what they have to say about ketones.

"Ketones in the urine is a sign that your body is using fat for energy instead of using glucose because not enough insulin is available to use glucose for energy. Ketones in the urine is more common in type 1 diabetes."

Since fat burning is what we're after, I'm not sure I would be overly concerned about it. Make sure your endocrinologist is aware because it could possibly indicate an insulin problem and listen to their advice, but I think it just means your body is doing what you want it to do.

*Disclaimer* I am not a physician or certified practitioner. My knowledge comes from years of working with juvenile diabetes patients and should not be taken as medical advice in your specific situation.

I don't know about the ketones, but I did want to comment on the hydration issue.

I found early out that I have to have more than the standard 64 oz of water a day to stay properly hydrated. I never really have symptoms of dehydration either, but I do lose better, have lower bp, and have clearer urine when I drink at least 90 oz a day, not counting protein shakes. I know that a lot of us are told early out that we can count the shakes as part of our fluid, but I quit doing that because I caught myself drinking less overall when I thought of the protein drink as fluid.

I'm not an expert, but my understanding is that 64 oz a day is more of a minimum than a goal.

Also, if it was a strip test, those are not the most accurate. So, I would follow up and find out what your levels look like for your blood sugar, protein in your urine and other blood tests to check specific levels.

High protein/low carb is going to induce a ketonic state. Push fluids, high protein "CAN" be hard on your kidneys if there is a pre-existing issue with your kidney function especially secondary to diabetes.

I was diabetic for 8 years and also had out of check Ketones. I assume you have type 2 obesity on set diabetes as did I. I could never get a straight answer from my PCP and was told that if I did away with the Diabetes, Ketones would return to normal. I don't know if it's tied into the A1C or not, but my higgest A1C and at my heaviest (500lbs.) was an 11. Very bad! Almost 2 years out now and A1C is 3.2. I also had a very heavy, dark urine stream for the first 3 months or so after surgery and sometimes still do. What I can say, is if you're in the gym; stay there. I didn't do any type of weight training and lost a huge amount of muscle mass. This might be the key if your body is starting to "attack" the lean muscle, which is what I think happened to me. Things that were not heavy before are now. Don't know if it's atrophy or not. I was taken off of all my Diabetes medication about 8 months out (Metformin & Byetta) and if you severly limit you carb intake and get regular excersize you should be good to go.

Your starting weight and first results sound alot like mine. I lost 63 pounds pre-op and was weight training and doing cardio during that time and my strength was great. Since surgery no weight training (I'm four weeks post-op and one month follow up is today so we will see what the doc says) but I did notice after surgery and over the last few weeks that my strength is greatly reduced. I mean...I'm struggling to even open lids of things like the pickle jar for my Mom! EEK!

Glad to see that maybe getting back into the gym can help with that. I have always been a strong girl and I don't want to lose my "Jack Johnson" type strength!

I am not a doctor but it sounds good to me. You had surgery a little over a week ago and you should be in ketosis right about now. The concern should be that you are a diabetic and you might need further testing. I think your doctor should have shed more light instead of just using jourgon language, I think I might have mispelled it but I think you know what I mean. She should have spoken to you in lay mens terms and should have explained your labs more in details. Good luck in your journey and do follow up with your other doctors just as you have planned. My guess is that if there was something extremely dangerous your doctor would have done more labs or sent you to the emergency room..